ABSTRACT Teratomas are germ cell tumours arising as the result of abnormal development of totipotential cells. They are commonly encountered in the gonads and occasionally found in mediastinum. We report a case of asymptomatic 28 years old lady with concomitant mature cystic teratoma in her mediastinum and left ovary which was diagnosed incidentally during health check up. This case is reported because of its rare and unusual coexistence.

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Perioperative management of patients with an anterior mediastinal mass is difficult. We present a 35-year-old woman who showed delayed compression of the carina and left main bronchus despite no preoperative respiratory signs, symptoms, or radiologic findings due to an anterior mediastinal mass and uneventful stepwise induction of general anesthesia. Even use of a fiberoptic bronchoscope (FB) after induction of anesthesia was not helpful to predict delayed compression of the airway. Therefore, the anesthesiologist and the cardiothoracic surgeon must prepare for unexpected delayed compression of the airway, even in low risk patients who are asymptomatic or mildly symptomatic without postural symptoms or radiographic evidence of significant compression of structures. We also describe successful management for the compressed carina and left main bronchus with a double lumen tube (DLT) as a stent during surgery. FB guided DLT intubation is a possible solution to maintain airway patency.

06/2014; 6(6):E99-E103. DOI:10.3978/j.issn.2072-1439.2014.04.30

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CA S E R E PO R T .IntroductionTeratomas are germ cell tumours commonly composed of multiple cell types derived from one or more of the three germ layers. Teratomas range from benign, well-differentiated (mature) cystic lesions to those that are solid and malignant (immature) (1). Arising from totipotential cells, they can be gonadal or extra gonadal tumours occurring in midline or paraxial. The most common location is sacrococcygeal but also commonly encountered in ovary. Cystic teratomas arising from the sequestered embryonic cell rest are less frequent and seen in mediastinal, retroperitoneal, cervical, and intracranial (2). We report a rare case of 28 years old asymptomatic lady diagnosed incidentally during health check up, harbouring synchronous mature cystic teratomas in her ovary and mediastinum (3). .Case historyA 28 years old newly married lady during her routine medical health check up before leaving to Middle east was found to have right paracardiac shadow in her chest X-ray (Figure 1). She had no complains of breathlessness, abdominal pain, nausea, vomiting, loss of appetite or weight and bowel/bladder disturbances. She Double whammy - mediastinal and ovarian teratoma: a rare clinical co-existenceLeo Francis Tauro, Prathvi Shetty, Aruna Kamath, Ashok Shetty Father Muller Medical Collage and Hospital, Mangalore, Karnataka, IndiaABSTRACT Teratomas are germ cell tumours arising as the result of abnormal development of totipotential cells. They are commonly encountered in the gonads and occasionally found in mediastinum. We report a case of asymptomatic 28 years old lady with concomitant mature cystic teratoma in her mediastinum and left ovary which was diagnosed incidentally during health check up. This case is reported because of its rare and unusual coexistence. Mediastinal tumour; ovarian tumour; teratoma; cystic tumourKEY WORDS J Thorac Dis 2012;4(4):434-436. DOI: 10.3978/j.issn.2072-1439.2012.03.09

Journal of Thoracic Disease, Vol 4, No 4 August 2012435addition to surgery. They are classified as mature or immature on the basis of the presence of immature neuroectodermal elements within the tumor. The more immature elements within the tumour the more chances of them being malignant (4).The anatomic distribution of the tumours along the lines of migration of the primordial germ cells from the yolk sac to the primitive gonads supports the parthenogenic theory hence they occur both in gonadal and extra gonadal location (1).Sacrococcygeal teratomas are most common and seen in newborns. Mature cystic ovarian teratoma are also quite common nearly forming 20% of ovarian neoplasm usually seen in second and third decade of life while testicular benign teratomas are quite rare (5,6). The same can be said of mediastinal tumours which are rare representing 8% of all tumours of this region occurring most commonly in adults aged 20-40 years (7).AFP and B HCG are usually within reference range in benign teratomas and elevated levels may be indicative of malignancy. Work up for cystic teratomas is largely radiographic and their appearance is similar despite varying locations. USG findings show regionally bright echos, hyper echoic lines and flat lines. CT usually reveals complex appearance with dividing septas, internal debris, fat attenuation and distinct calcification, as was in our case which leads to the diagnosis of benign mature teratoma of mediastinum and ovary (8). MRI can sufficiently differentiate lipid from other fluids also useful adjunct for diagnosis. These tests helped us differentiate it from ectopic pregnancy, benign Figure 2. A. CT scan Axial view of chest at level of cardia showing a well defined cystic mass in right para cardia with smooth thick wall and area of focal calcification. The cystic content are heterogeneous with predominant fat density; B. Coronal section CT scan showing large cystic lesion in pelvis and lower abdomen and mass lesion in the mediastinum.Figure 1. Chest X-ray showing right para cardiac shadow.AB